Diagnostic and Invasive Colonoscopy are not Risk Factors for Revision Surgery Due to Periprosthetic Joint Infection

Document Type

Journal Article

Publication Date



The Journal of arthroplasty




Arthroplasty; Colonoscopy; Database; Periprosthetic Joint Infection; Retrospective Study; Revision Surgery


BACKGROUND: Colonoscopy is routinely performed for colorectal cancer screening in patients who have a pre-existing unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) prostheses. However, colonoscopy is theorized to provoke transient bacteremia, providing a potential nidus for periprosthetic joint infection (PJI). This study aimed to investigate the risk of aseptic and septic revision surgery in patients who underwent diagnostic colonoscopy or invasive colonoscopy within one-year following UKA, TKA, or THA. METHODS: A retrospective cohort analysis was performed using a national database. Patients were identified using Current Procedural Terminology (CPT). In total, 52,891 patients underwent UKA, 1,049,218 underwent TKA, and 526,296 underwent THA. Data were analyzed with univariate analysis preceding multivariable logistic regressions to investigate outcomes of interest at 2 and 3 years from the index procedure. RESULTS: Diagnostic colonoscopy resulted in no increase in odds of all-cause or septic revision surgery for any prostheses. At both time points, invasive colonoscopy resulted in lower odds of all-cause revision (p<0.05) for patients with UKA, decreased odds of septic revision (p<0.001) for patients with TKA, and decreased odds of both all-cause and septic revision (p<0.05) for patients with THA. CONCLUSION: Our results show that diagnostic colonoscopy was not a significant risk factor for revision following UKA, TKA, or THA. Paradoxically, invasive colonoscopy was protective against revision, even with very minimal use of antibiotic prophylaxis observed. This study addresses the theory that colonoscopy procedures may threaten an existing joint prosthesis via transient bacteremia and shows no increase in revision outcomes following colonoscopy.


Orthopaedic Surgery